50 瓦与 40 瓦在阵发性心房颤动高能短时间消融中的对比：一项多中心前瞻性研究。
50-W vs 40-W During High-Power Short-Duration Ablation for Paroxysmal Atrial Fibrillation: A Multicenter Prospective Study.
机构信息
Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Ohio, USA.
Cardiac Arrhythmia Center, Division of Cardiology, Las Vegas, Medellin, Colombia.
出版信息
JACC Clin Electrophysiol. 2023 Dec;9(12):2573-2583. doi: 10.1016/j.jacep.2023.08.005. Epub 2023 Oct 4.
BACKGROUND
High-power short-duration (HPSD) radiofrequency ablation of atrial fibrillation (AF) increases first-pass pulmonary vein isolation (PVI) and freedom from atrial arrhythmias while decreasing procedural time. However, the optimal power setting in terms of safety and efficacy has not been determined.
OBJECTIVES
This study compared the procedural characteristics and clinical outcomes of 50-W vs 40-W during HPSD ablation of paroxysmal AF.
METHODS
Patients from the REAL-AF prospective multicenter registry (Real-World Experience of Catheter Ablation for Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation) undergoing HPSD ablation of paroxysmal AF, either using 50-W or 40-W, were included. The primary efficacy outcome was freedom from all-atrial arrhythmias. The primary safety outcome was the occurrence of any procedural complication at 12 months. Secondary outcomes included procedural characteristics, AF-related symptoms, and the occurrence of transient ischemic attack or stroke at 12 months.
RESULTS
A total of 383 patients were included. Freedom from all-atrial arrhythmias at 12 months was 80.7% in the 50-W group and 77.3% in the 40-W group (Log-rank P = 0.387). The primary safety outcome occurred in 3.7% of patients in the 50-W group vs 2.8% in the 40-W group (P = 0.646). The 50-W group had a higher rate of first-pass PVI (82.3% vs 76.2%; P = 0.040) as well as shorter procedural (67 minutes [IQR: 54-87.5 minutes] vs 93 minutes [IQR: 80.5-111 minutes]; P < 0.001) and radiofrequency ablation times (15 minutes [IQR: 11.4-20 minutes] vs 27 minutes [IQR: 21.5-34.6 minutes]; P < 0.001) than the 40-W group.
CONCLUSIONS
There was no significant difference in freedom from all-atrial arrhythmias or procedural safety outcomes between 50-W and 40-W during HPSD ablation of paroxysmal AF. The use of 50-W was associated with a higher rate of first-pass PVI as well as shorter procedural times.
背景
高能短时间（HPSD）射频消融治疗心房颤动（AF）可提高初次通过肺静脉隔离（PVI）的成功率和无房性心律失常的比例，同时缩短手术时间。然而，在安全性和有效性方面，最佳的功率设置尚未确定。
目的
本研究比较了 50W 与 40W 在阵发性 AF 的 HPSD 消融中的手术特点和临床结果。
方法
REAL-AF 前瞻性多中心注册研究（治疗症状性阵发性和持续性心房颤动的导管消融的真实世界经验）纳入了接受 HPSD 消融的阵发性 AF 患者，根据使用的功率（50W 或 40W）分为两组。主要疗效终点是无任何房性心律失常。主要安全性终点是 12 个月时任何手术并发症的发生。次要终点包括手术特点、AF 相关症状以及 12 个月时短暂性脑缺血发作或中风的发生。
结果
共纳入 383 例患者。50W 组 12 个月时无任何房性心律失常的比例为 80.7%，40W 组为 77.3%（Log-rank P=0.387）。50W 组有 3.7%的患者发生主要安全性终点事件，40W 组为 2.8%（P=0.646）。50W 组初次通过 PVI 的比例更高（82.3% vs 76.2%；P=0.040），手术时间（67 分钟 [IQR：54-87.5 分钟] vs 93 分钟 [IQR：80.5-111 分钟]；P<0.001）和射频消融时间（15 分钟 [IQR：11.4-20 分钟] vs 27 分钟 [IQR：21.5-34.6 分钟]；P<0.001）均短于 40W 组。
结论
在阵发性 AF 的 HPSD 消融中，50W 与 40W 之间在无任何房性心律失常或手术安全性方面无显著差异。使用 50W 可提高初次通过 PVI 的比例，并缩短手术时间。
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